Dr. Hotez cited vaccine hesitancy as a contributor to the resurgence of preventable diseases.
On Jan. 30, Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, presented the talk “Vaccines in an Age of Conflict, Global Instability, Climate Change and Antiscience.”
The talk was presented as a part of the Hopkins School of Medicine Distinguished Speaker series, a lecture series designed to bring intellectual work and creative scholarship to the med campus.
For his talk, Hotez emphasized the importance of vaccines in today’s global world, citing his experience as one of the world’s leading experts in the field of vaccine development. His research on vaccines centers around neglected tropical diseases (NTDs), a group of communicable diseases that are especially prevalent in tropical and subtropical environments.
Vaccines have been critical to the global elimination of infectious disease in history. Hotez described his experience as a pediatric infectious disease fellow in the late 1980s, when the fear of deadly infectious illnesses such as polio and measles reached an all-time high.
“Your heart sank, because you knew there was a high likelihood the child would die,” Hotez said as he described observers’ reactions to his measles patients.
But as Hotez described, progress has been made since the 1980s on disease elimination. For example, the world has reached nearly complete global elimination of polio and measles. This is in large part due to the development of vaccines.
“It’s an amazing success story,” Hotez said.
However, there was one weakness to that goal: the fact that there were many other diseases that researchers needed to tackle. In his career, Hotez made the decision to devote himself to what he said were known as “other diseases,” now known as NTDs.
Current enumerations show tens of millions of people being affected by neglected diseases such as scabies, ascariasis, rabies and other chronic and debilitating illnesses. One that he specifically devoted his time to was female schistosomiasis.
Despite the lack of global attention, female schistosomiasis may be one of the main gynecological diseases in Africa. There, it affects over 40 million girls and women, who face symptoms such as pain, bleeding, depression and the social stigma associated with contracting the genital disease.
Girls and women who are affected are ostracized for being diagnosed with a sexually transmitted infection (STI) when in reality, it is caught from swimming or other activities.
“Getting people to care about this has been very tough,” Hotez said.
One way he has tried to make an impact with this and other NTDs is by delivering donated pharmaceutical company medicines and administering them as mass treatments.
Hotez explains that in order to raise awareness for this effort, he had to step out of his lab in order to lobby and campaign.
“I would go outside the White House and congressional offices to explain the critical effects of this package” he said.
The effort was a success: Hotez managed to get Congress to allocate nearly $100,000 per year to treat about a billion people annually for about seven NTDs, which has led to the growing elimination of some of these diseases.
Despite the progress that has been made, Hotez explained that due to several determinants, the success of this vaccine campaign is unraveling. This is due to the combined effects of factors such as climate change; war and political collapse; urbanization and deforestation; shifting poverty; and the rise of antiscience.
“All of that is combining to see the return of vaccine preventable diseases,” Hotez explained.
Hotez described hot spots where researchers are seeing steep, sharp increases in diseases that were entirely unanticipated. However, after analyzing the location of these increases and the effects of the combined determinants, the reasons become clearer.
First, Hotez explained the effect of politics in the Arabian peninsula, where Syria faces the Aleppo Evil, a disease that causes permanent scarring on the face.
The formerly ISIS-occupied area also shows signs of aggressive urbanization and the effects of a global rise in temperatures. Yemen, due to the proxy wars of Saudi Arabia and Iran, has seen the world’s largest cholera epidemic in history.
Beyond Arabia, Venezuela suffers from similar effects due to the Bolivarian revolution. After the election of Chavez and Maduro’s succession, the country saw a return of measles even after it was thought to have been eliminated.
Second, Hotez described the shifting nature of poverty that occurs on top of that instability. The people affected by NTDs are primarily the poor living among the wealthy in Group of 20 countries with severe wealth disparities. This includes the U.S.
“This has been part of the hardest struggle I’ve ever had,” Hotez explained. “After the home run we’ve had in people accepting NTDs, this one has been a strikeout.”
Hotez explains this is in large part due to the association of issues such as NTDs with immigrants, which he dismisses as a myth.
Finally, Hotez describes the effects of antiscience on the increase in diseases. Numbers of extinct diseases like measles returning to the U.S. have gone up in large part due to vaccine hesitancy, defined as the rejection of life-saving medicine despite their availability.
A study often cited by proponents of the anti-vaccination movement, which describes a link between autism and vaccination, was retracted in 2010 due to elaborate fraud and conflicts of interest revealed in the author’s work.
Between 1998 and 2010 however, vaccine hesitancy caused an unrestrained spread of misinformation amongst parents.
Hotez attributes the rise of antiscience to a few main causes: the media, which he says helps spread misinformation and conspiracy theories for quick views, and anti-vaccination political machines, which use jargon such as “health freedom” and “medical choice” to rally supporters.
Another cause of the increase of antiscience is what Hotez calls “deliberate predation.” He said that in 2017, anti-vaccination supporters went to Somali immigrant communities to promote fear of vaccinations, which led to a measles epidemic.
Then again, the same epidemic occurred with the Jewish Orthodox community in New York through the spread of pamphlets that used Holocaust imagery to turn people against vaccination.
The pattern continued in Harlem, using rhetoric from the Tuskegee trials as a comparison to vaccination.
But there is a solution to this rise of antiscience, Hotez explained.
Instead of focusing on grants and papers, Hotez encourages scientists to take an active role with members of the community and the public.
“We’re going to have to train a new squadron of young people” Hotez said. “I think we’re going to have to make that investment as a profession.”